Pulmonary thromboendarterectomy in chronic thromboembolic pulmonary hypertension: a report of 15 cases

Chronic thromboembolic pulmonary hypertension [CTEPH] is a serious and underdiagnosed disorder with significant morbidity and mortality. It is thought to result from single or recurrent pulmonary thromboemboli arising from the sites of venous thrombosis, often from the lower limbs. Surgical correction of anatomical obstructions [endarterectomy of pulmonary artery] is the treatment of choice in these patients, and the patients outcomes are good. The mortality rate in some centers is about 5%, but in others it is up to 30%. We started pulmonary endarterectomy in Shaheed Rajaie Heart Center [RHC] in Iran four years ago. Pulmonary thromboendarterectomy is performed under hypothermia and total circulatory arrest with cardiopulmonary bypass. All patients are evaluated in our hospital for known risk factors of deep vein thrombosis and pulmonary emboli. Right heart catheterization and measurement of pulmonary artery pressure and vascular resistance are performed in some of the patients and left heart catheterization in those who are over 45 years of age. CT angiography of the pulmonary artery with multi-slice CT scan is done in all patients before and after endarterectomy. Patient selection for successful endarterectomy is based on CT angiography and perfusion lung scan with consideration of pulmonary vascular resistance in some cases. During a 4-year period, 15 patients [5 female and 10 male] underwent this type of surgery in RHC. Their mean age was 35.87 [min. 18, max. 55] years old. The mean pulmonary artery systolic pressure by echocardiography was 87.60 mmHg [min. 55mmHg, max. 140 mmHg, SD 23.26 mmHg] and the mean pulmonary artery pressure was 46.43mmHg [min. 23 mmHg, max. 60 mmHg, SD 11.70 mmHg]. Mean surgery time was 5.33 hours [min. 4hrs, max. 14 hrs, SD. 2.46 hrs], mean bypass time was 138 minutes [min. 84, max. 220, SD=43.28 minutes], mean intubation time was 49.88 hours [min. 7 hrs, max. 216 hrs, SD 61.66 hrs], and intensive care unit stay time was 5.43 days [min. 3, max. 9, SD=1.98]. Two fatalities occurred due to bleeding and shock. The mortality rate was 20%. IVC filters were placed in a minority of the patients who had clear-cut evidence of lower extremity deep vein thrombus as a cause of pulmonary thromboembolic events. Pulmonary endarterectomy is the treatment of choice in CTEPH with an acceptable mortality rate and a good prognosis. It is possible to perform this procedure without recourse to more sophisticated evaluations with an acceptable mortality rate in patients who have segmental lobar or main pulmonary artery organized clot

[Molecular identification of mycoplasma agents in suspected contagious caprine pleuropneumonia]

Contagious Caprine Pleuropneumonia [CCPP] is one of the common infections in the middle east regions. So far, there has not been received any report about isolation and identification of these agents in Iran. The aim of this study is to diagnose and isolate mycoplasma agents in suspected goat flocks. Total of 100 pneumonic lung specimen from 20 CCPPsuspected flocks were collected from abbatoirs close to Kermanshah during 1384-1386 and had been sent to Microbiology Lab. Gross lesions showed hepatization with grey and white lesions [consolidation] and motley appearance with or without fibrin. The minced tissue were inoculated to PPLO broth agar. After multiple passages, typical mycoplasma colony was isolated from 4 flocks [22/2%]. Mycoplasma DNA was also extracted based on phenolchloroform method and subjected to generic PCR with specific primers. In addition to the perivious positive samples from tissue culture, 5other flocks also showed contamination with Mycoplasma organisms in PCR tests[45%]. Then, the samples were determined for Mycoplasma mycoides cluster infection, M. capricolum capripneumonia and M. mycoides mycoides [L.C], using M. agalactia as negative control, with specific primers in PCR, there has showed no contamination to these strains. However, to declare "free status " from CCPP in goat flocks requires more developed researches and much more samples in further investigation

[Molecular studies on avian leukosis virus subgroup I [ALV-J] infections in grandparent flocks in Iran]

Subgroup J Avian Leukosis Virus [ALV-J] was isolated in the late 1980s from meat-type chickens in the United Kingdom. ALV-J with exception of some acute variants, cause myeloid leukosis in meattype chickens with long incubation period. In this study while the status of Avian Leukosis Virus Subgroup J in six different strain of broiler grandparent flocks of Iran evaluated, the evaluation of different primers and some molecular methods also were done. For this reason, 100 blood samples, which had EDTA, 100 mixed of white blood cells and plasma and 100 feather pulps were collected from one farm of each broiler grandparent strain. PCR and nested PCR were methods that used for the study. In molecular study before the extraction of DNA from samples; In order to decrease the number of samples, 10 mixed of white blood cells and plasma, blood or feather pulp pooled. In molecular study with PCR all of samples were negative, but in nested PCR reaction, from six broiler strains, five strains infected to ALV-J. The results indicate that the most of broiler strains in Iran have been infected to ALVJ. The results also indicate that we can simply use pooled samples for the study of ALV-J in a flock by nested-PCR test